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164 Cards in this Set
- Front
- Back
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What makes pregnancy a high risk?
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concurrent d/o
pregnancy related complication or external factor jepordizes health of the mother, fetus, or both |
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What needs to be done if there is an active lesion at time of delivery?
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C/S
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What may a Dr do for the last 4 wks to prevent an active lesion from forming?
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put on antibiotics
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What is group B strep?
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has a higher incidence with STDs
can be deadily to baby |
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What can happen to a baby exposed to group B strep?
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develop pneumonia
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How will a mother will group B strep be treated?
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penicillin 5 million initially then 2.5 million q4h until delivery
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When would a pregnant woman be tested for HIV?
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1st visit
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When would the baby of an HIV positive woman be tested?
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@ birth, 3 mo & 6 mo
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Why might a baby be HIV+ at birth but not at 3 or 6 mo?
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b/c of maternal antibodies
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What would an HIV + pregnant woman be treated with during labor?
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AZT
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What should a pregnant woman not do with her baby?
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breastfeed
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What is the most common type of anemia?
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iron
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What would a pregnant woman need to do if she has iron deficiency anemia?
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take iron supplements with her PNVs
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What are the best foods to take iron with?
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citrus fruits, fish, polutry
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What should a pregnant woman increase if taking iron supplements to prevent constipation?
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fluid and fiber
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What can asymptomatic UTI lead to?
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pyleonephritis
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What can pyleonephritis lead to?
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pre labor or ruptured membranes
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When are pregnant woman tested for UTIs?;
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every visit
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What are the s/s of pyelonephritis?
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pain in lumbar, fever
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How are UTIs treated?
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aggressive antibiotics
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What would mom be treated with if she had TB?
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INH
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What can mom not do if she and baby are treated with INH?
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breastfeed
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Why do underlying cardio problems become a problem when preg?
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increased blood vol
increased HR increased CO |
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When is blood vol at its peak during pregnancy?
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28-32 wks
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What is classification 1 of heart ds?
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umcompromised
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What is classification 2 of heart ds?
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slightly compromised
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What is clasification 3 of heart ds?
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markedly compromised
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What is classification 4 of heart ds?
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severly compromised
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What would a woman with classification 4 of heart ds be advised not to do?
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get preg
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What is peripartal cardiomyopathy?
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left ventricular dysfunction
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What are the s/s of peripartal cardiomyopathy?
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SOB, chest pain, edema
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Why are oral contraceptives are contraindicated with peripartal cardiomyopathy?
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increased risk of thrombophlebitis
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When does peripartal cardiomyopathy occur?
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late in pregnancy or postpartum
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How can you treat peripartal cardiomyopathy?
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diuretics, digoxin, limited activity
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How can you prevent anemia during pregnancy?
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treat with PNV and additional iron supplement
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What is the goal of care with cardiovascular ds?
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to maximize the health of mother and baby
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What should be included in intrapartum care?
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vital signs *02 & breath sounds
I/O labor in side lying position 02 administration epidural concerns medications support |
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When should the valsalva maneuver be avoided?
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if there are any cardio problems
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What may be used to avoid the valsalva maneuver?
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foreceps or vacuum
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What should be included in postpartum care?
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early ambulation
prophylactic antibiotics avoid constipation continuation of PNVs and iron increase fluid and fiber |
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Why is thromboembolytic ds more common in pregnancy?
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venous stasis
impeded blood return to uterus hypercoagulate stage of pregnancy |
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What can thromboembolytic ds lead to?
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pulmonary embolus
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What should be taught for a pt at risk for thromboembolytic ds?
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don't cross legs
avoid wearing constrictive hose ambulate frequently |
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How can you treat DVT during pregnancy?
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anticoagulants
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Why would you discontinue anticoagulants during labor?
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to prevent hemorrhage
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How long after delivery would anticoagulants be given?
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6 mos
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What is diabetes?
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an inadequate production of insulin b/c the pancreas doesn't produce enough
inadequate utilization of insulin adequate carb metabolism doesn't occur |
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What are the s/s of diabetes?
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increased thirst, urination, hunger
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What is insulin resistance in pregnancy due to?
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HPL
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What are some other complications associated with diabetes during pregnancy?
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hydraminos
PROM PTL PIH congenital anomalies |
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What are some fetal risks with diabetes?
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LGA
SGA |
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Why would a baby be at risk for hypoglycemia after delivery?
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liver is use to mom's high levels of glucose so it over produces insulin dropping gluose levels too low
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When is the screening for gestational diabetes done?
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28 wks
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How is the gestational diabetes screening done?
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drink 50g carb drink and test w/in an hour
drink 100g carb drink and test when fasting for 6 hr, 1,2,3 hr |
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How do you determine if a woman has gestational diabetes?
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if 2 of 4 are elevated
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How can you see if a woman is maintaining her glucose levels?
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hbA1c
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How many cals are required if a woman has gestational diabetes?
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2200-2400
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What is included in the antepartum fetal surveillance of a diabetic mom?
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evaluated by ultrasound, NST, biophysical profile
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When is glucose checked during labor?
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q2h
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If mom is on insulin during labor when is glucose checked?
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q1h
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What should glucose levels be maintained at during delivery?
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80-120mg/dL%
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What could bleeding in the first trimester indicate?
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abortion/miscarriage
ectopic pregnancy |
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What could bleeding in the second trimester indicate?
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hydatiform mole
incompetent cervix |
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What could bleeding in the third trimester indicate?
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placenta previa
abruptio placenta |
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What is an abortion/miscarriage?
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interruption of a pregnancy before the fetus is viable (<24wks)
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What would you assess for with a miscarriage?
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amount of bleeding, type of bleeding, presence of tissue
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What would bright bleeding during a miscarriage indicate?
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currently happening
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What would brown blood during a miscarriage indicate?
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already happened
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What are some complications of a miscarriage?
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hemorrhage
infection isoimmunization (rh ds) |
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What is the treatment for a miscarriage?
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confirmation of preg
determine cause of bleeding |
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What should be done if the miscarriage is inevitable?
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IV fluids
sedation D&C to remove everything |
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What is an ectopic pregnancy?
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occurs when site of implantation is anywhere but the uterus
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What are the s/s of an ectopic pregnancy?
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sharp, one sided pain
s/s shock referred shoulder pain abdominal pain tenderness over rupture on palpation palpation of a mass abdominal rigidness |
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What is the treatment of an ectopic pregnancy?
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diagnosis of pregnancy
removal of affected tube rhogam if Rh- |
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What is a hydatiform mole?
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trophoblastic tissue that usually grows into the placenta grows but the fetus doesn't grow
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What are the s/s of a hydatiform mole?
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rapid growth of uterus, absent fetal HR, HA, blurred vision, increased N/V, proteinuria, swelling, bleeding
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How can you treat a molar pregnancy?
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D&C
monitoring HcG levels possible chemo possible hysterectomy |
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What is a molar pregnancy a precursor for?
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chorion cancer
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Why would someone with a molar pregnancy be put on birth control?
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to prevent preg until cancer is controlled
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What is an incompetent cervix?
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premature dilation of cervix and inability to hold fetus
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When would the fetal typically be lost with an incompetent cervix?
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16-24 wks
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What would be a sign of an incompetent cervix?
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painless bleeding
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How could you diagnosis an incompetent cervix?
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repeated 2nd trimester losses
early gestational cervical change painless bleeding followed by quick delivery |
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How can you treat an incompetent cervix?
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cerclage
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What is a cerclage?
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suture placed in cervix and tied shut
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When is a cerclage removed?
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36wks
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What is a placenta previa?
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at or covering the cervical opening
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How could a placenta previa be diagnosed?
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U/S
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What is a sign of placenta previa?
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painless bleeding, small or life threatening
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How can you treat a placenta previa?
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depends on gestational age
bed rest no pelvic exams assessment for s/s of shock bleeding assessment possible imminent delivery if at risk for hemorrhage or fetal compromise |
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What can woman with placenta previa not have?
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pelvic exam
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What is a complete placenta previa?
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If the placenta covers the cervix completely
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What is a low lying placenta previa?
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If the edge of the placenta is within 2 centimeters of the cervix but not bordering it
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What is a marginal placenta previa?
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If it's right on the border of the cervix
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What is a partial placenta previa?
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to a placenta that covers part of the cervical opening once the cervix starts to dilate
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What is abruptio placenta?
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premature separation of the placenta prior to delivery
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What are some predisposing factors to an abruptio placenta?
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PIH
chronic HTN abdominal trauma cocaine abuse |
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What are some s/s of an abrupito placenta?
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severe abdominal pain
bleeding rigid uterus |
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Why does the uterus start contracting with an abruptio placenta?
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trying to get the blood out
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What is the treatment for an abruptio placenta?
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fetal monitoring
oxygen administration imminent delivery |
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What would you do if the fetus was bradycardiac and the mom had an abruptio placenta?
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straight to OR
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What is DIC?
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disseminated intravascular coagulation
such extreme bleeding that so many platelets and fibrin rush to the site of insult that there is not enough left in circulation to provide further clotting |
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What is DIC usually a complication of?
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PIH
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What is PIH?
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pregnancy induced HTN
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What are the symptoms of PIH?
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HTN
proteinuria edema HA epigastric pain SOB |
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When does PIH occur?
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not until about 24 wks, last 10 wks, during labor, or 48 hrs postpartum
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How can you diagnose PIH?
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systolic increase of 30, diastolic increase of 15 2 readings 6 hrs apart
proteinuria 1-2+ wt gain >2lb/wk in 2nd trimester and 1lb/week in 3rd trimester |
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What is eclampsia?
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seizure
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What are some maternal risks for eclampsia?
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renal failure
abrupiton DIC pulmonary embolism ruptured liver |
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What are some fetal risks for ecalmpsia?
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SGA- may have to dliver early d/t poor placental perfusion
intrauterine growth retardation |
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What should be included in antepartum management?
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promote bedrest
promote good nutrition provide emotional support fetal surveillance monitor maternal vitals monitor maternal labs antihypertensives if indicated |
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What would a pt lose if their Mg was 8-12mg/dl?
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patellar reflexes
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How would a pt feel if their Mg was 9-12mg/dl?
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warm, flushing
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How would a pt present with a Mg level of 10-12mg/dl?
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somnolence
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How would a pt's speech be with a Mg level of 10-12mg/dl?
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slurred speech
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How would a pt's muscle be with a Mg level of 15-17mg/dl?
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muscular paralysis
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How would a pt's respiratory effort be with a Mg level of 15-17mg/dl?
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difficult
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How would a pt present with a Mg level of 30-35mg/dl?
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cardiac arrest
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What is the therapeutic level of Mg?
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4.8-6.9mg/dl
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What is the cure for PIH?
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delivery
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What is the preferred delivery of someone with PIH?
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vaginal
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What is HELLP syndrome?
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PIH with hepatic focus
endstage of PIH |
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What are the s/s of HELLP?
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N/V, epigastric pain, extreme RQ pain, malaise
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What does HELLP stand for?
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H- hemolytic RBCs
E- elevated liver enzymes L- liver function L- low <100,00 P- platelets |
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Where is there an elevated liver function in HELLP?
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hemorrhage and necrosis of liver
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Why should you watch for bleeding with HELLP?
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low platelet count
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What is Rh disease?
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antigen/antibody immunologic reaction
if mom is Rh- and has a Rh+ fetus, the moms antibodies can cross the placenta and attack the baby's RBCs |
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When would an Rh- mom be treated?
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28wks, after any procedure that may cause bleeding, within 72hours of delivery if baby is Rh+
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What would be some signs of multiple gestation?
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uterus larger than expected
AFP greater than expected |
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What is hydraminos?
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fluid volume > 2000ml
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What would be a sign of hydraminos?
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larger than expected fundal height w/o multiples
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What is the management for hydraminos?
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hopsitalization
bed rest monitor for PTL observation for PROM cord prolapse |
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What is hypermesis gravidarum?
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persistent vomiting beyond 12 wks
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What can hyperemesis gravidarum result in?
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dehydration, weight loss, ketonuria
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What is post-term pregnancy?
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> 42 weeks
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What is the danger of post-term pregnancy?
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placental insufficiency
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What would be an indication of placental insufficiency?
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late decceleartions
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What is the management of a post-term pregnancy?
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weekly surveillance beginning at 40 wks
induction with indication of stress |
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What are some things that could cause fetal death?
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chromosomal abnormalities
maternal d/s congenital malformations requires delivery |
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What is premature labor?
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labor that occurs before the end of week 37 of gestation
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What are some predisoposing factors for premature labor?
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infection
UTI/pyelo adolescents advanced maternal age previous hx hydraminos smokers |
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What is the management for premature labor?
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bedrest
tocolytic therapy |
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What are tocolytics?
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labor inhibiting drugs
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What is terbutaline?
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labor inhibiting drug
usually initiated first |
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What is the protocol for terbutaline?
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3 doses of 0.25mg SQ given 15 minutes apart
follow with 2.5-5mg PO w/in 30 minutes depending on contractions |
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What does a pt on terbutaline have to placed on?
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EKG
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When would terbutaline not be given?
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if HR is > 130
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What are the s/s of terbutaline?
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increased HR
decreased BP increased FHR hypocalcemia pulmonary edema HA dizziness |
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How is Mg sulfate given and how much?
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IV only
4-6 gm load 2-4 gm/hr after first load |
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What should be watched for with a pt getting Mg sulfate?
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toxicity
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What is indocin?
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prostaglandin inhibitor
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How and how much of indocin is given?
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50mg supp
25mg PO q6h |
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Why is indocin only given for 72 hrs?
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causes a decrease in amniotic fluid
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What is procardia?
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calcium channel blocker
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How and how much of procardia is given?
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10-30mg PO q8h
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Why would betalmethazone and dexamethazone be given for PTL?
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mature fetal lungs
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How much and when is betalmethazone given?
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12mg, 2 does 24 hrs apart
IM |
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How much and when would dexamethazone be given?
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6mg, 4 does 12 hrs apart
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Will PTL meds work if the cervix is > 5cm?
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no
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What PROM?
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ROM prior to 37 wks
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What are the fetal risks of PROM?
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contracture of limbs
increased risk for infection increased for PTL/preterm birth fetal lung immaturity increased risk for prolapsed cord |
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What is the assessment for PROM?
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observation for LOF
fern test amnisure cervical observation for leakage or pooling US to measure amnitoic fluid volume |
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What is an amnisure?
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dip in fluid, send to lab
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What is an intrazine test?
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pH turns dark blue but urine can also turn it blue so not 100%
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